After your lung surgery

Department of thoracic surgery Information for Patients i

Leaflet number: 257 Version: 2.1 Produced: Feb 2019 Review: Oct 2021 Introduction This booklet aims to explain:

 What to expect when you return home to recover after your surgery

 What is considered ‘normal’ and when to seek help

 Where to go for advice or support after you go home (discharge)

Being discharged home

Whilst in hospital you will have a daily review from our doctors. This is usually during a morning ward round. The doctors will explain when you are medically fit to go home- this will usually happen later that same day. Please note that most discharges do not happen until the afternoon. This gives us time to make sure everything is ready for you to have a safe discharge

 Once the doctor has completed the paperwork for your discharge, any medication you need will be ordered from the hospital pharmacy. The hospital pharmacy can be very busy. They do try to give medications quickly, but you may have a 2-4 hour wait.

 Once your discharge has been confirmed, you may be asked to leave the ward and go to the discharge lounge at Glenfield Hospital. This is an area where patients can wait for their family or friends to collect them. The staff in the discharge lounge can give you any medication that you require. Whilst there please ask the staff should you need anything to keep you comfortable.

 If you are in employment, please ask your doctor how long you should expect to be off work

2 You will be given:

 Medication and letters for your GP and/ or community nurse if you need stitches or clips removing. A copy of this will also be posted to your GP.  Sometimes patients go home with a chest drain. If this happens, you will be given the chest drain information and equipment. Further information can be found on pages 13-15 of this booklet.  A spare pair of stockings, if required. These should be worn to help prevent blood clots in your legs (also known as deep vein thrombosis). These should be worn for six weeks or until your mobility is back to your normal level.  Please ask for a ‘fitness to work’ certificate if you need one before leaving the ward. Getting out and about/ exercising

 Most patients will be worried about going home – your confidence will soon return. It is very important that you keep active following lung surgery. The worst thing you can do following your discharge home is take to your bed and not be mobile. This increases the risk of post operative complications such as chest infections, deep vein thrombosis and pressure sores.

 You should get up and go to bed at your normal time. Have an afternoon nap if required, but for no longer than one hour. Set an alarm to wake you up. Do not stay in your bed. Even if sat upright in bed your lungs do not expand properly and the risk of complications such as chest infections increases.

3 Getting out and about/ exercising

 Aim for a brisk walk, twice a day, gradually increasing distance and pace. You should aim to feel a little short of breath (able to walk and talk). This level of exercise will help your recovery without making you too tired.

 Get out and about. Often patients can feel low in mood after surgery so it is important to spend time with your family and friends.

 Go shopping with family or friends, lean on the trolley if you need to!

 Remember that we are all individuals and all heal at different rates.

 Aim to get back to your normal levels of activity within around six weeks of surgery.

Looking after yourself  By the time you go home you will be able to wash and dress yourself. You will be walking around the ward and hospital.

 Ladies: bras can be uncomfortable for a while. Non-wired bras tend to be more comfortable while your wounds are healing.

 You can cook but avoid lifting heavy pots or pans. Ready meals are often ideal for the first few days after going home.

 Light dusting is acceptable, but avoid vacuuming or moving heavy objects for several weeks until you can carry out these movements without significant discomfort.

 Some shortness of breath is to be expected - this will depend on the type of surgery you have had and your general fitness.

4 Looking after yourself (continued)

 Remember to keep as mobile as you can to aid your recovery. It is okay to go up and down stairs, and go out for walks even when the weather is cold - just wrap up warmly.

 You need to be slightly breathless when exercising/being mobile. This proves that you are working hard enough! It will help your lung to fully expand and will reduce the risk of chest infections.

 Rebuild your stamina/endurance to what is normal for you – this isn’t always a quick process and can take weeks or months. Pain or discomfort

 You should expect to have some soreness but you should not be in so much pain that your day-to-day activities are restricted. Being active reduces the risks of chest infection, pressure sores and blood clots.

 Patients often report some numbness or change in feeling (sensation) to the front of the chest on the side of their surgery. This is normal and relates to the nerve pathways under the ribs.

 It is normal to experience shooting or stabbing pains as any nerves damaged at the time of surgery repair themselves. These sensations can last for several months.

 You should take your painkillers as prescribed. should be the last painkiller to be stopped. Paracetamol is very effective if you take two tablets, four times a day.

 Please contact the Thoracic Nurse Specialists if you need advice about reducing your painkillers. You can also ask the doctors at your follow-up appointment.

 Your painkillers are highly likely to make you constipated. You must take the laxatives prescribed for you - usually Lactulose or

Senna. They only work if taken regularly. 5 Eating and drinking Sometimes appetite is reduced after an operation and you may lose some weight. You should try to eat small meals that contain more calories than you would normally eat. You can achieve this by including full-fat milk, spreads and high calorie additions to your normal diet.

Bowels

Drink plenty of water. Eating two to three pieces of fruit and three portions of vegetables a day can help reduce constipation. Consult your GP if this problem carries on.

Looking after your wounds  Try not to touch the wounds, this helps to reduce the risk of infection.

 Your wound should be left without dressings if clean and dry. This will help it heal more quickly.

 You can shower but do not scrub the wound and avoid using perfumed products until completely healed. If having a bath please do not sit with the wound submerged in water as this can delay healing.

 You may have stitches (sutures) or clips that need to be removed by the practice nurse at your local GP surgery. The nurses on the ward will give you a letter and a date for these to be removed. These stitches are normally removed seven to ten days after drain removal.

 The scabs from the chest drain site can take several weeks to fall off. Please do not pick them as doing so may cause infection.

6 Stockings You may have been given special stockings to wear after surgery. These help to improve circulation and reduce the risk of developing blood clots in your legs – this is known as deep vein thrombosis or DVT. You should wear the stockings until you return to your normal level of activity, usually up to six weeks after you have gone home. You should wear these day and night and ask for a spare pair to allow for washing.

Posture and shoulder movement

 Try and maintain an upright position – you can check how upright you are in a mirror.

 Gentle side stretches away from your operated side may help your posture.

 Keep your shoulders moving.

 If you have shoulder movement problems that don’t go away ask your surgeon or GP for a physiotherapy assessment.

Emotions

Any sort of operation can affect people emotionally and mentally, so it is usual to have feelings of anxiety or depression. Try talking about your feelings; remember your friends and family need to talk things over as well. Try to have realistic goals. Remember you can telephone the thoracic nurse specialists if you are finding this difficult.

7 Sex Sexual relationships can be resumed when your wounds are healed, within the limits of your comfort and when you and your partner are ready. This may take several weeks. Remember your partner may be worried about hurting you. Try taking a more passive role.

Driving, work and flying

Driving It is essential that you can perform an emergency stop without pain when you start driving again. This can vary from two to six weeks after surgery. We recommend that you discuss when you can start driving again with the doctor at your outpatient check up or with your GP. Remember to inform your insurance company that you have undergone chest surgery. This should not affect your policy, but if you do not phone to check it could affect your insurance cover. Work Please ask the medical staff for advice at your outpatient check up or discuss with your GP. You can return to work when you feel well and comfortable. This might depend on your occupation and the surgical procedure carried out, but generally patients return after one to three months. Flying You can normally fly three months after lung surgery, please check at your outpatient appointment.

8 Medications to take home Do

 Always read the label and follow the instructions given by your nurse, doctor or pharmacist. If you don’t understand - Ask

 Ideally take at the same time each day. If this is a problem then contact your pharmacist.

 If you have pain that doesn’t get better, talk to your GP and never take more than the maximum dose stated on the container.

 Store medications safely away from children and pets and protect from heat and light.

 Always keep tablets in their original labelled packaging.

 Swallow tablets whole with a glass of water, unless instructed otherwise.

 Tell your pharmacist what tablets you are taking if buying other medications from the pharmacy.

 If you need more ask your GP for a further supply.

 Medicines can be confusing as the same one can have different names. Please ask if you are at all unsure.

 Any concerns please contact the Thoracic Specialist Nurse on 0116 250 2552. Don’t

 Never share medicines with others or use theirs.

 If you miss a dose, take it as soon as you remember but never double up, as this can be dangerous.

 Medication can cause drowsiness. Do not drive your car unless advised otherwise by your doctor. 9 Painkillers - also known as

Normally after surgery you are given a supply of painkillers.

Paracetamol (Brand names used include Panadol®) Most patients are given a supply of paracetamol for discharge. Unless told otherwise, paracetamol is very effective if taken regularly. A normal dose is two tablets, every four hours, with a maximum of eight tablets in 24 hours. When taken as prescribed this painkiller has very few side effects. Please be aware that other painkillers and cold remedies may have Paracetamol in them, so if in doubt please check with your pharmacist. You should never take anything else containing paracetamol whilst taking paracetamol tablets. Co-codamol (Brand names used Paracodol®, Solpadol®,Tylex®,Kepake®) Co-codamol contains both paracetamol and in one tablet. It is available in a variety of strengths (eg codeine 8mg and paracetamol 500mg is called 8/500). NEVER take other medicines containing paracetamol whilst taking co-codamol. If you have any concerns please see your pharmacist. (Brand names used Zydol®, Zamadol®) Tramadol should not be taken if you have a history of epileptic seizures. For some patients tramadol can cause hallucinations or confusion. Dihydrocodeine (Brand name DF118®) This can be taken alongside paracetamol. Never take other medicines containing codeine whilst taking Dihydrocodeine.

10 Common side effects Co-Codamol, Tramadol and Dihydrocodeine are stronger painkillers that can cause some side effects such as feeling or being sick, and constipation. You may need to use a ‘laxative’ if taking these painkillers regularly. Please remember never to take paracetamol and co-codamol together. Do not take extra painkillers without checking with your GP or pharmacist. You may stop taking your painkillers when you feel you no longer need them. Remember paracetamol should be the last painkiller to be stopped unless otherwise directed.

A variety of painkillers are available both on prescription and on sale in pharmacies and shops. You must check that your doctor knows what you are taking before giving you with another prescription. If you are unsure please ask the pharmacist for advice.

Non-steroidal anti-inflammatory agents (NSAIDs) such as (brand names, Brufen® and Nurofen®) and diclofenac (brand name, Volterol®). This category of painkiller is used to reduce stiffness and inflammation. They should be taken with food or straight after food. Possible side effects include indigestion or stomach pains - taking your tablets with food helps this.

11 Anti-ulcer Sometimes if you are taking a certain painkillers or have a history of stomach problems you may be given an anti-ulcer . This may have been prescribed to protect the lining of your stomach. It works by reducing the amount of acid made by the stomach. Common anti-ulcer drugs are: Lansoprazole Zoton®Omeprazole Losec®Esomeprazole Nexium®Ranitidine Zantac® Possible side effects are: altered bowel habits and tummy pain. If you are worried about any possible side effects or if you have any problems please see your GP or pharmacist. Laxatives

Senna (brand names include Senokot®) is a laxative that works by encouraging the bowel to contract and move the waste products along the bowel, helping you to go to the toilet. In order to maintain healthy bowel function, a healthy diet containing fibre is important. Whole grain breads and cereals, bran, fruit and green leafy vegetables should be eaten everyday along with drinking water. Daily exercise is important too. Lactulose (brand names include Duphalac®, Lactugal®) is an effective laxative that softens poo (faeces) by increasing the amount of water in the large intestine. It is quite common for senna and lactulose to be prescribed together as they both work in different ways. Common side effects of laxatives include stomach cramps and flatulence. Laxatives can be stopped when normal bowel movements have been re-established.

12 Outpatient appointment

You are usually sent an outpatient appointment by post 2-4 weeks after you have been discharged. You will usually have a chest x-ray, your wounds will be checked and the doctor will ask how you have been recovering. You may also be told results from the operation. You may want to bring a friend or family member with you to this appointment. After this appointment you may be given another appointment to see the lung surgery team. You may also be referred to another Consultant or you may be discharged from follow-up appointments. Your doctor may decide that you are well enough to go home but

Going home with a chest drain you still need to have your chest drain. This is usually due to fluid still draining into the bag or due to a small air leak caused by the lung surface taking a while to heal. You will be shown how to look after the drain. You will be referred to a District nurse. They will be asked to visit you every few days to keep an eye on the drain site. They will change the site dressing approximately every 2-3 days if the dressing is dry. They will change it more often if needed. The doctors and Thoracic Nurse Specialist will want to see you again one week after you go home. This is to check if the drain is ready to be removed. They will want to know roughly how much fluid has drained each day. It is a good idea to record the amount of fluid drained every night. You should then empty the bag to prevent spillage overnight.

13 Going home with a chest drain There are some simple rules to remember: Do

 read the booklet provided

 empty your chest drain bag every night

 look for changes in the amount and type of drainage

 continue to exercise

 seek advice if your breathing becomes difficult

 if you have any concerns contact the Thoracic Nurse Specialist or ward 26.

Don’t

 disconnect your drain

 pull at the drain or stitches

 allow the bag to lie flat, as it may spill

 block the port for emptying the bag

 forget the bag is connected to you!

You will be given full instructions, written information and clamps. You will also be referred to the community (district) nurses for support.

14 Record your drainage

Date Amount Comments

Remember - You are an individual. You will get better in your own time - try not to compare yourself with others. Listen to your body. Exercise is vital to your recovery but must be balanced with rest.

Support is available at: Mesothelioma UK - National Macmillan Mesothelioma Resource Centre Helpline: 0800 169 2409 Website: www.mesothelioma.uk.com Macmillan Cancer Support - Helpline: 0808 808 0000 Website: www.macmillan.org.uk

15 If you need further help, please contact: Thoracic Nurse Specialist - 0116 250 2552 Ward 26 0116 258 3666/ 2484 (evenings/ weekends) For urgent medical attention: Call 111 or 999

Leicester’s Hospitals is a research active trust so you may find research is happening on your ward or in your clinic.

To find out more about the benefits of research and become involved yourself, speak to your clinician or nurse, call 0116 258 8351 or visit www.leicestersresearch.nhs.uk/patient-and-public-involvement

For maps and information about visiting Leicester’s Hospitals visit www.leicestershospitals.nhs.uk

If you would like this information in another language or format such as EasyRead or Braille, please telephone the

number below or email [email protected]

0516 0516 -

0116 250 2959 RES043

To give feedback on this leaflet contact [email protected]

Re-use of this leaflet is restricted by Creative Commons license Previous code: